Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy

BACKGROUND: Direct insertion of the trocar is an alternative method to Vere ss needle insertion for the creation of pneumoperitoneum. The safety of dir ect disposable shielded trocar insertion for the creation of pneumoperitone um was assessed by comparing with Veress needle insertion during laparoscop ic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperito neum were included in this study. In 470 patients the Veress needle inserti on technique was used, and in 1,030 patients direct trocar insertion techni que was used. Patients having indications for open trocar insertion were ex cluded from the study. RESULTS: Complication rate was significantly higher in the Veress needle gr oup (14% versus 0.9%; P <0.01), and the two major complications, gastric pe rforation and iliac artery laceration, were also encountered in this group. CONCLUSIONS: Our results suggest that with a lower complication rate, direc t insertion of the disposable trocar is a safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creatio n of pneumoperitoneum. (C) 1999 by Excerpta Medica, Inc.